This review assesses the effectiveness of interventions to reduce physical restraint (PR) use in older people living in nursing homes or residential care facilities. A systematic search of studies published in four electronic databases (MEDLINE, CINHAL, PsycINFO, Cochrane Central Register of Controlled Trials). The review included individual and cluster randomized controlled trials that compared educational training and multicomponent programs to avoid PR use. Risk bias of randomized controlled trials (RCTs) was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. This review includes 16 studies in a qualitative synthesis that met the inclusion criteria, nine of them offered a multicomponent program and seven offered only educational training. The results of the 12 studies included in the meta-analysis showed a significant trend in favor of intervention over time and intensity of PR use tends to decrease. The review indicates that educational programs and other supplementary interventions should be effective, but the heterogeneous operative definition of physical restraints can make difficult data generalization.

Despite the worldwide promotion of a “restraint-free” model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses’ feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient’s bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person.

Background:The Person-centered Care Assessment Tool (P-CAT) was developed as a self-reporting assessment scale for the healthcare staff ratings of the person-centeredness of their nursing practice.Aim:This study investigates the psychometric proprieties of P-CAT tool in a sample of staff working in residential units for older people, in the North of Italy.Methods:Internal consistency and reliability were examined using the Cronbach’s alpha coefficient. Exploratory factor analysis was used to evaluate construct validity, homogeneity analysis performed to evaluate internal homogeneity of the items and equidistance of item options, test–retest reliability examined by the Pearson correlation coefficient and the intraclass correlation (ICC) coefficient. The P-CAT score was standardized to a 100-point scale, the score differences among groups were compared with one-way ANOVA.Results:The exploratory factor analysis supported the construct validity of a two-factor solution. The mean standardized score of P-CAT was 67.3 (SD 12.8) and Cronbach’s alpha was .79 for subscale 1 and .75 for subscale 2. The ICC coefficient was .87.Conclusion:Reliability and homogeneity were satisfactory for the whole P-CAT tool (Cronbach’s alpha ≥ .70). Test–retest reliability showed temporal stability of the scale (r Pearson .86, ICC .86). The Italian version of the P-CAT was found to be valid, reliable, and applicable for further research. Two subscales are recommended for the Italian version.

Physical restraints in the long-term care setting are still commonly used in several countries with a prevalence ranging from 6% to 85%. Trying to have a broad and extensive overlook on the physical restraints use in long-term care is important to design interventions to prevent and/or reduce their use. Therefore, the aim of this scoping review was to analyze the range of occurrence of physical restraint in nursing homes, long-term care facilities, and psychogeriatric units. Pubmed, CINAHL, Ovid PsycINFO- databases were searched for studies with concepts about physical restraint use in the European long-term care setting published between 2009 and 2019, along with a hand search of the bibliographies of the included studies. Data on study design, data sources, clinical setting and sample characteristics were extracted. A total of 24 studies were included. The median occurrence of physical restraint in the European long-term care setting was still high (26.5%; IQR 16.5% to 38.5%) with a significant variability across the studies. The heterogeneity of data varied according to study design, data sources, clinical setting, physical restraint’s definition, and patient characteristics, such as ADLs dependence, presence of dementia and psychoactive drugs prescription.